Healthy eating can be a major behavioral change

Eating slowly can help you eat less

The relationship between depression and obesity is well established. What condition comes first is less clear.

In an analysis published in the Archives of General Psychiatry, depressed persons had a 58 percent increased risk of becoming obese, while obese persons had a 55 percent increased risk of developing depression over time.

“Eating is often a way of managing mood,” explained Dr. Sandra L. Crump, a psychologist at the Weight Center at Massachusetts General Hospital. “Food cheers us up.”

Changing eating patterns involves identifying the cause of overeating, she explained. In addition to depression, anxiety and stress are also contributors to overeating. When Crump asks people how they were feeling when they were eating, a typical response is “I felt lonely or I felt sad.”

Realizing the link between emotion and food is a good first step, she said. Yet, some people cannot connect the dots. Even worse, many people don’t recognize they are depressed. Crump was quick to point out that not all people with obesity are depressed or anxious. Sometimes it’s just a matter of education about nutrition and portion sizes.

Healthy eating is a major behavioral change. “We are creatures of habit,” she explained. For instance, some people may be used to eating a snack just before bed — whether they are hungry or not. It has become a conditioned response. Or it may just be a hold-over from childhood but a habit hard to break.

A more difficult task is helping people learn to decipher when they are full. That seems pretty obvious, but for many who overeat, there is a big disconnect between the head and the stomach. One method Crump suggested is to stop eating and wait for about 20 minutes. If you still feel hungry after the pause, then continue eating.

Another method is to eat slowly. Because of busy schedules, we’re used to wolfing down an entire meal in a few bites.

“Take a break,” she said. “Recognize internal cues. Recognize that you are full.”

Satiety, or a sense of fullness, is controlled by the interplay of the stomach, digestive hormones and the brain. Eating slowly or taking a break allows the systems to communicate with one another to send cues of fullness. It takes a while for the brain to get the message.

But that could be part of the problem.

People who are obese can have a problem deciphering when they are full. A recent study published in the Journal of Clinical Endocrinology found that the digestive hormones can lose their ability to help obese people feel full after a meal. The reduced signals cause people to compensate with increased meal size or frequent food intake.

Crump warned that new behavior never erases old behavior. “They’re still there, but not in control,” she explained. In all probability a person will lapse and revert to the previous eating behavior. “We anticipate relapses,” she said. “There are different skills in losing weight than in maintaining weight.”

A misstep is not a failure, she cautioned, just a hiccup. People recycle through stages of change all the time. “Don’t be too judgmental,” she advised.

Crump recognizes that cultural differences in eating habits and acceptance of a rounder figure can be a deterrent to weight loss. Obesity and overweight are more prevalent and more culturally accepted among black and Hispanic women.

There is often the misperception that weight loss results in a change of shape. “You don’t lose your curves,” explained Crump. You just have less padding surrounding those curves, she added.

People need to look at where they are and where they want to be. Personal goals are driving forces. For example, excess weight may prevent doing some things comfortably, or clothes may be too snug. Most critical for success in changing one’s eating behavior is the support of family and significant other, Crump said.

Her biggest piece of advice is to learn to identify the triggers or feelings that might set you off track and keep one thing in mind. “You don’t have to eat over it,” she said. “There are other ways to feed your soul.”